Fertility Problems: Should I Be Tested?

You may want to have a say in this decision, or you may simply want to follow your doctor's recommendation. Either way, this information will help you understand what your choices are so that you can talk to your doctor about them.

Fertility Problems: Should I Be Tested?

1

Get the
Facts

2

Compare
Options

3

Your
Feelings

4

Your
Decision

5

Quiz
Yourself

6

Your Summary

Get the facts

Your options

Have tests to try to find out the cause of infertility.
Don't have tests. To make family planning decisions, use the information you already have.

Key points to remember

If you are younger than 35 and are trying to get pregnant (conceive), most doctors suggest trying well-timed sex for at least 1 year before thinking about testing. The best time to conceive is just before ovulation. Some people find that they have been missing their most fertile days when trying to conceive.
If you are a woman 35 or older and have tried well-timed sex for 6 months, you might want to think about infertility testing before age-related problems make it too hard to conceive.
Infertility tests may find what is causing the problem. Sometimes you can be treated at the same time.
Testing and treatment can be stressful, costly, and sometimes painful. You may need only a few tests, or you may need many tests over months and years.
If you decide to have infertility testing, talk with your doctor about how much testing you are willing to do and for how long. You may only want to have tests for problems you are willing to treat or that will help you move on to other options, such as adoption.
Tests can't always find the cause of infertility. And not all infertility problems can be treated.

FAQs

What is infertility?

You may be infertile if you have not been able to get pregnant after trying for at least 1 year (or 6 months if you're over 35).

A woman's fertility slowly drops from her mid-30s into her 40s because of the natural aging of the egg supply. A man's fertility is not affected as much by age.

Defining infertility is a personal issue. It can depend on your age and how much time you choose to spend trying to get pregnant without medical help.

What kinds of problems lead to infertility?

Most cases of infertility are caused by a problem with the reproductive system. This can include:

Problems with the eggs or releasing an egg (ovulating).
Problems with the uterus or the fallopian tubes. This may be caused by things like endometriosis or pelvic inflammatory disease.
Problems with the sperm. These problems may include how sperm is made, how it functions, or how it moves.
An unknown issue. Sometimes the cause of infertility is not known.

It can be stressful to find out the reason for infertility. Knowing where the problem is may create feelings of guilt and blame and may put strain on your relationship. Not being able to find any cause can also create stress. You may want to talk with a counsellor or join an infertility support group before you make your decision. Talking with other people can help you feel less alone.

What types of tests are done?

Tests for infertility can range from a simple blood test to surgery.

Basic tests can show if there are problems with eggs or sperm. Depending on the results, the test may be repeated, or you will be treated with medicines and hormones. These tests may include:
- Basal body temperature tests.
- Blood tests.
- Semen analysis.
Advanced tests check the reproductive organs. These tests look for diseases or fertility problems that might be treated. These tests may include:
- Hysterosalpingogram. This checks the fallopian tubes and can clear them if a blockage is found. The test may be done with or without ultrasound.
- Laparoscopy. This test looks at reproductive organs and checks for problems such as endometriosis.
- Hysteroscopy. This test looks for growths or defects in the uterus that can't be seen with other tests.
- Sperm antibody test. This test shows whether sperm have been damaged by antibodies.

How can you use the test results?

Based on your test results, your doctor can help you decide about your next testing or treatment option. Take some time to think about what you have learned from each test and what you want to do next.

For example, if your first test results are normal and no clear reason is found for your fertility problem, you may:

Keep trying to conceive on your own, having sex just before ovulation to increase your chances of getting pregnant.
Have advanced tests to find out a cause for your fertility problem. These tests will check your fallopian tubes to be sure that eggs can enter the tubes, be fertilized, and start to grow in the uterus. The tests may involve cutting or poking, and they have risks, such as cramping or infection.

Tests can't always find the cause of infertility. And not all infertility problems can be treated.

Depending on the results of these tests, your doctor may suggest treatment, such as:

Insemination, with or without ovulation medicine.
A fallopian tube procedure or in vitro fertilization (IVF) to conceive a pregnancy.
Laparoscopy, to look for problems with your fallopian tubes or ovaries.

Before you decide about testing, think about:

How important is it for you to know why you haven't become pregnant?
How will test results affect your family planning?
How will you deal with the stress of testing?
How much will it cost? Talk with your doctor and your health insurer about costs.

What else do you need to know about testing?

Testing and treatment can be costly, stressful, and sometimes painful. Before starting, talk about how much testing you are willing to do and for how long.

You may decide to have the basic tests only and to stop when you have enough information. Or instead of advanced testing and treatment, you may decide to keep trying to get pregnant on your own or to adopt a child. Your decision will be based on your health, age, goals, and values.

Why might your doctor recommend infertility testing?

Your doctor might advise you to have infertility testing if:

You are younger than 35, have regular menstrual periods, and have had sex during your fertile window (the 6 days each month that you can become pregnant) for at least 1 year.
You are 35 or older, or you have irregular periods and have had sex during your fertile window for at least 6 months.
You are at high risk for fertility problems and have had sex during your fertile window for a few months.
You have had several miscarriages.
It would be easier for you to make family planning decisions with test results.

Compare your options

Compare


What is usually involved?
What are the benefits?
What are the risks and side effects?

Have infertility testing Have infertility testing

You have one or more infertility tests to find out why you are having problems getting pregnant.
You keep track of how often you have sex, and you talk about this with your doctor.
You decide how much testing to do, and you stop when you have enough information. Based on the test results, you may decide to get fertility treatment.

You may be able to find out why you are having problems getting pregnant.
Some tests can find the problem and treat it at the same time.

You may need many tests over many months or years. Tests can't always find the cause of infertility. And not all infertility problems can be treated.
Testing is stressful and can be costly.
Basic tests, such as semen analysis and blood tests, have no risks or side effects, and they don't cause pain.
Advanced tests or surgery may require a cut in the skin and can be painful. They have a higher chance of problems after the test, such as cramping or infection.

Don't have infertility testing Don't have infertility testing

You keep trying to conceive on your own, having sex just before ovulation to increase your chances of getting pregnant. Some people find that they have been missing their most fertile days when trying to conceive.
You consider other options for parenting, such as adoption or raising a foster child.

You avoid the cost, stress, and risks of infertility testing.

You may have an infertility problem that can be treated, but you may not know it.

Personal stories about infertility testing

These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.

I've been trying now for about 5 or 6 months and still haven't gotten pregnant. But I'm not sure that I've been having sex at the right time of the month, so I got some information about how to calculate the fertile time. I'm going to see if working on the timing for a few months helps.

Lynn, age 33

I didn't have any trouble getting pregnant with my first child. But my second husband and I have been trying to have a baby for about a year now, and I still haven't gotten pregnant. Since he doesn't have any children of his own, we can't be sure which one of us may have a problem. We have been having sex at the right times. We agree that it's time to find out whether there may be a problem.

Rosa, age 32

I'm 35 and my partner is 38. We have been trying for 6 months, and it doesn't seem to be happening. We decided to see a doctor to talk about the next step.

Carol, age 35, and Dave, age 38

We've been trying to conceive for 10 months now. But since we are both still young, we aren't too worried yet. My spouse is going to try tracking each menstrual cycle to see if that helps before we take the next step. If that doesn't help, I'll consider having my sperm checked.

James, age 27, and Sabra, age 26

What matters most to you?

Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.

Reasons to have infertility testing

Reasons not to have infertility testing

Having a biological child is very important to me.

Having a biological child is not that important to me.

More important

Equally important

More important

I'm not worried about the cost of infertility testing.

I'm worried about the cost of testing.

More important

Equally important

More important

I think I can handle the stress of testing.

I'm not sure that I can handle the stress of testing.

More important

Equally important

More important

I accept that testing may not be able to find a problem or treat it if one is found.

I don't want to have a lot of tests that may not find my problem or treat it.

More important

Equally important

More important

I know that having these tests means talking with doctors about our sex life.

I'm not comfortable talking about our sex life.

More important

Equally important

More important

My other important reasons:

More important

Equally important

More important

Where are you leaning now?

Now that you've thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now.

Having infertility testing

NOT having infertility testing

Leaning toward

Undecided

Leaning toward

Your Summary

Here's a record of your answers. You can use it to talk with your doctor or loved ones about your decision.

Your decision

Next steps

Which way you're leaning

How sure you are

Your comments

Your knowledge of the facts

Key concepts that you understood

Key concepts that may need review

Getting ready to act

Patient choices

What matters to you

Print Summary

Credits

Author	Healthwise Staff
Primary Medical Reviewer	Sarah Marshall MD - Family Medicine
Primary Medical Reviewer	Anne C. Poinier MD - Internal Medicine
Primary Medical Reviewer	Adam Husney MD - Family Medicine
Primary Medical Reviewer	Kathleen Romito MD - Family Medicine
Primary Medical Reviewer	Femi Olatunbosun MB, FRCSC - Obstetrics and Gynecology

Fertility Problems: Should I Be Tested?

Here's a record of your answers. You can use it to talk with your doctor or loved ones about your decision.

Get the facts
Compare your options
What matters most to you?
Where are you leaning now?
What else do you need to make your decision?

1. Get the Facts

Your options

Have tests to try to find out the cause of infertility.
Don't have tests. To make family planning decisions, use the information you already have.

Key points to remember

If you are younger than 35 and are trying to get pregnant (conceive), most doctors suggest trying well-timed sex for at least 1 year before thinking about testing. The best time to conceive is just before ovulation. Some people find that they have been missing their most fertile days when trying to conceive.
If you are a woman 35 or older and have tried well-timed sex for 6 months, you might want to think about infertility testing before age-related problems make it too hard to conceive.
Infertility tests may find what is causing the problem. Sometimes you can be treated at the same time.
Testing and treatment can be stressful, costly, and sometimes painful. You may need only a few tests, or you may need many tests over months and years.
If you decide to have infertility testing, talk with your doctor about how much testing you are willing to do and for how long. You may only want to have tests for problems you are willing to treat or that will help you move on to other options, such as adoption.
Tests can't always find the cause of infertility. And not all infertility problems can be treated.

FAQs

What is infertility?

You may be infertile if you have not been able to get pregnant after trying for at least 1 year (or 6 months if you're over 35).

A woman's fertility slowly drops from her mid-30s into her 40s because of the natural aging of the egg supply. A man's fertility is not affected as much by age.

Defining infertility is a personal issue. It can depend on your age and how much time you choose to spend trying to get pregnant without medical help.

What kinds of problems lead to infertility?

Most cases of infertility are caused by a problem with the reproductive system. This can include:

Problems with the eggs or releasing an egg (ovulating).
Problems with the uterus or the fallopian tubes. This may be caused by things like endometriosis or pelvic inflammatory disease.
Problems with the sperm. These problems may include how sperm is made, how it functions, or how it moves.
An unknown issue. Sometimes the cause of infertility is not known.

What types of tests are done?

Tests for infertility can range from a simple blood test to surgery.

Basic tests can show if there are problems with eggs or sperm. Depending on the results, the test may be repeated, or you will be treated with medicines and hormones. These tests may include:
- Basal body temperature tests.
- Blood tests.
- Semen analysis.
Advanced tests check the reproductive organs. These tests look for diseases or fertility problems that might be treated. These tests may include:
- Hysterosalpingogram. This checks the fallopian tubes and can clear them if a blockage is found. The test may be done with or without ultrasound.
- Laparoscopy. This test looks at reproductive organs and checks for problems such as endometriosis.
- Hysteroscopy. This test looks for growths or defects in the uterus that can't be seen with other tests.
- Sperm antibody test. This test shows whether sperm have been damaged by antibodies.

How can you use the test results?

For example, if your first test results are normal and no clear reason is found for your fertility problem, you may:

Keep trying to conceive on your own, having sex just before ovulation to increase your chances of getting pregnant.
Have advanced tests to find out a cause for your fertility problem. These tests will check your fallopian tubes to be sure that eggs can enter the tubes, be fertilized, and start to grow in the uterus. The tests may involve cutting or poking, and they have risks, such as cramping or infection.

Tests can't always find the cause of infertility. And not all infertility problems can be treated.

Depending on the results of these tests, your doctor may suggest treatment, such as:

Insemination, with or without ovulation medicine.
A fallopian tube procedure or in vitro fertilization (IVF) to conceive a pregnancy.
Laparoscopy, to look for problems with your fallopian tubes or ovaries.

Before you decide about testing, think about:

How important is it for you to know why you haven't become pregnant?
How will test results affect your family planning?
How will you deal with the stress of testing?
How much will it cost? Talk with your doctor and your health insurer about costs.

What else do you need to know about testing?

Testing and treatment can be costly, stressful, and sometimes painful. Before starting, talk about how much testing you are willing to do and for how long.

Why might your doctor recommend infertility testing?

Your doctor might advise you to have infertility testing if:

You are younger than 35, have regular menstrual periods, and have had sex during your fertile window (the 6 days each month that you can become pregnant) for at least 1 year.
You are 35 or older, or you have irregular periods and have had sex during your fertile window for at least 6 months.
You are at high risk for fertility problems and have had sex during your fertile window for a few months.
You have had several miscarriages.
It would be easier for you to make family planning decisions with test results.

2. Compare your options

	Have infertility testing	Don't have infertility testing
What is usually involved?	You have one or more infertility tests to find out why you are having problems getting pregnant. You keep track of how often you have sex, and you talk about this with your doctor. You decide how much testing to do, and you stop when you have enough information. Based on the test results, you may decide to get fertility treatment.	You keep trying to conceive on your own, having sex just before ovulation to increase your chances of getting pregnant. Some people find that they have been missing their most fertile days when trying to conceive. You consider other options for parenting, such as adoption or raising a foster child.
What are the benefits?	You may be able to find out why you are having problems getting pregnant. Some tests can find the problem and treat it at the same time.	You avoid the cost, stress, and risks of infertility testing.
What are the risks and side effects?	You may need many tests over many months or years. Tests can't always find the cause of infertility. And not all infertility problems can be treated. Testing is stressful and can be costly. Basic tests, such as semen analysis and blood tests, have no risks or side effects, and they don't cause pain. Advanced tests or surgery may require a cut in the skin and can be painful. They have a higher chance of problems after the test, such as cramping or infection.	You may have an infertility problem that can be treated, but you may not know it.

Personal stories

Personal stories about infertility testing

These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.

"I've been trying now for about 5 or 6 months and still haven't gotten pregnant. But I'm not sure that I've been having sex at the right time of the month, so I got some information about how to calculate the fertile time. I'm going to see if working on the timing for a few months helps."

— Lynn, age 33

"I didn't have any trouble getting pregnant with my first child. But my second husband and I have been trying to have a baby for about a year now, and I still haven't gotten pregnant. Since he doesn't have any children of his own, we can't be sure which one of us may have a problem. We have been having sex at the right times. We agree that it's time to find out whether there may be a problem."

— Rosa, age 32

"I'm 35 and my partner is 38. We have been trying for 6 months, and it doesn't seem to be happening. We decided to see a doctor to talk about the next step."

— Carol, age 35, and Dave, age 38

"We've been trying to conceive for 10 months now. But since we are both still young, we aren't too worried yet. My spouse is going to try tracking each menstrual cycle to see if that helps before we take the next step. If that doesn't help, I'll consider having my sperm checked."

— James, age 27, and Sabra, age 26

3. What matters most to you?

Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.

Reasons to have infertility testing

Reasons not to have infertility testing

Having a biological child is very important to me.

Having a biological child is not that important to me.

More important

Equally important

More important

I'm not worried about the cost of infertility testing.

I'm worried about the cost of testing.

More important

Equally important

More important

I think I can handle the stress of testing.

I'm not sure that I can handle the stress of testing.

More important

Equally important

More important

I accept that testing may not be able to find a problem or treat it if one is found.

I don't want to have a lot of tests that may not find my problem or treat it.

More important

Equally important

More important

I know that having these tests means talking with doctors about our sex life.

I'm not comfortable talking about our sex life.

More important

Equally important

More important

My other important reasons:

More important

Equally important

More important

4. Where are you leaning now?

Now that you've thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now.

Having infertility testing

NOT having infertility testing

Leaning toward

Undecided

Leaning toward

Credits

By	Healthwise Staff
Primary Medical Reviewer	Sarah Marshall MD - Family Medicine
Primary Medical Reviewer	Anne C. Poinier MD - Internal Medicine
Primary Medical Reviewer	Adam Husney MD - Family Medicine
Primary Medical Reviewer	Kathleen Romito MD - Family Medicine
Primary Medical Reviewer	Femi Olatunbosun MB, FRCSC - Obstetrics and Gynecology

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